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Evaluation of the Involvement of the Tempromandibular Joint in Patients with Osteoarthritis and the Accuracy of Ultrasonography as Compared to Computed tomography for Detection of Osteoarthritic Changes.
Author name:
احمد عادل عثمان
Supervisor name:
هاجر ابراهيم عبد الله
General topic:
Dentistry
Specific topic:
Oral and Maxillofacial Surgery
Degree:
Master
University:
Mustansiriyah University
Language:
English
University location:
Baghdad
First pages:
20T389 - p.pdf
Abstract:
خلفية البحث : اضطرابات المفصل الفكي الصدغي تشير الى مصطلح مركب يحتوي على عدة حالات تتضمن المفصل الصدغي ,التركيبات المحيطة او كلاهما , تظهر على شكل الم في منطقة المفصل والعضلات المرتبطة,وتحدد بالقدرة على الحركة الطبيعية مثل المضغ, الكلام والبلع. مرض التهاب | Tempromandibular joint disorders is a collective term embracing a number of conditions affecting the TMJ, the surrounding structures or both,manifested by pain in the area of joint and associated muscles, and limitation in the ability to make normal movement like mastication,speech and swallowing. Osteoarthritis is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion. A variety of causes—hereditary, developmental, metabolic, and mechanical deficits may initiate processes leading to loss of cartilage. When bone surfaces become less well protected by cartilage, bone may be exposed and damaged. As a result of decreased movement secondary to pain, regional muscles may undergo atrophy, and ligaments may become more lax.Objective of the study : • To determine the extent of tempromandibular joint involvement in patients with osteoarthritis.• To evaluate the correlation between clinical and radiographical findings. • To evaluate the accuracy of sonography in detection of osteoarthritic changes compared to Computed tomography.Materials and method : A comparative study had been done using thirty six symptomatic patients(24 female and 12 male) above 40 years diagnosed as osteoarthritis by specialist rheumatologist in Alkarkh general hospital, with clinical finding related to osteoarthritis like pain,tenderness,crepitation, clicking and limited mouth opening. these patients were exposed to computed tomography(CT) scan (Philips - Brilliance 64) in Al - Karkh general hospital and then the results were compared with sonographic findings (Philips 12.5 MHz transducer) to see the disc displacement, effusion, erosion, flattening, osteolytic and osteophytic lesions in the condylar head.The period of the study started from (october - 2013 to june - 2014).Results : The result of the study showed that the mean age of osteoarthritic patients was (49.69) years, and female percentage (66.7%) and male(33.3%). Chief complaine showed more predilection in the left side (28%) and bilateral showed(56%).Clinically : limitation in mouth opening (50%),crepitation(36.11%), clicking (27.7%), and tenderness (20.8%). Radiographically Computed tomography(CT) scan showed disc displacement (50%), joint effusion (37.5%), flattening(36.11%), osteophyte(18,05%), and erosion(11.1%). There was significant correlation between clicking and joint effusion in computed tomography(CT),while tenderness showed significant correlation with osteophyte and joint effusion in sonography. Other correlations were non significant correlation between clinical and radiological changes. Association between computed tomography(CT) and sonography showed fair agreement in osteophyte detection,fair agreement in joint effusion,moderate agreement in detection of joint erosion,moderate agreement in reduction of space and anterior disc displacement and also moderate agreement in condylar head flattening. Conclusions : Osteoarthritis in tempromandibular joint may be unilateral or bilateral. About 50% of Patients with osteoarthritis have limitation in mouth opening. Clinical findings play a major role in diagnosis of osteoarthritis. The tempromandibular joint changes in osteoarthritis were the results of degenerative processes, in contrast to rheumatoid arthritis were the changes as a result of the disease. Sonography was more likely to be sensitive rather than specific in detection of osteoarthritic changes
